Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

It’s Mom’s Fault Again

In the 1940s, autism was thought to be caused by the “refrigerator mothers,” who didn’t show enough love and affection to their children and thus made them incapable of interacting appropriately with other people. This theory hung on into the 1970s and was supposedly backed by science. Even Bruno Bettelheim supported the theory.

Later, mid-century, the refrigerator mother theory was resurrected to blame cold mothers for causing their children to be homosexual. (“Overbearing” mothers were thought to have the same effect. In essence, women couldn’t win.) Mothers were also blamed for schizophrenia.

All of these theories have been debunked. It seems they were a reaction to women joining the workforce and relying on childcare to fulfill the child-rearing functions previously provided by stay-at-home moms.

Now the blame-mom theory is back. Mother Jones magazine published an article in the September/October 2025 issue, “No, Moms Are Not to Blame for ADHD” by Chelsea Conaboy, reporting on how the theory has shifted and resurged, and how it still isn’t true.

Dr. Gabor Maté, a guest on Joe Rogan’s podcast, was promoting his fifth book, The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture. During that interview, Maté “explained” that “hyperactivity and poor impulse control develop in particularly sensitive babies who are adapting to stressed parents, especially mothers.” Stressed—read “inattentive” mothers—cause children to “tune out” and “that tuning out is then programmed into the brain.” Women who turn to doctors with questions and lists of their children’s behaviors are “obsessive and overly intellectual.” That is to say, the opposite of the ideal warm, nurturing mother who could have prevented the symptoms in the first place.

Maté’s emphasis on the maternal bond dates back to his first book, Scattered Minds, published in 1999. In it, he said, “All the behaviors and mental patterns of attention deficit disorder are external signs of the wound, or inefficient defenses against feeling the pain of it.” He says he bases his theories on “literature research… on hundreds of patient interviews, and on my clinical observations.” Stephen Faraone, professor of psychiatry, neuroscience, and physiology at SUNY Upstate Medical University and president of the World Federation of ADHD, says that Maté’s science is not cohesive and “cherry-picked.” Faraone also says that Maté’s theories can cause “real harm if it dissuades families from seeking evidence-based treatment, including effective medications.”

Reputable researchers say that ADHD is “highly heritable, with genetic differences accounting for as much as three-quarters of its prevalence.” The fact that rates are rising is more likely due to better diagnosis, especially in girls, who have been underdiagnosed and underrepresented. Maté has acknowledged a heritable component or “sensitivity,” which he says is then unlocked by the family environment.

There are other theories, of course. Secretary of the Department of Health and Human Services Robert F. Kennedy, Jr., attributes ADHD to chemical exposures. Erica Komisar, a clinical social worker and contributing editor at the Institute for Family Studies, says that the theory that parents can cause their child’s ADHD through stressors, including divorce, day care, and the “muddling” of traditional gender roles, is an inconvenient truth.”

It hasn’t passed unnoticed that the theory of maternal causes of ADHD supports the conservative view of what a family is and what a woman’s role in it should be. Stay-at-home moms are more valued because of their supposed innate nurturing nature. How that correlates with theories about “refrigerator” or “overbearing” mothers isn’t clear, since stay-at-home moms can theoretically be either. Working mothers are considered “stressors” that can bring about ADHD.

The take-away from all this? The best current science says that ADHD is largely an inheritable condition and that blaming mothering techniques is outdated and unfounded. The important consideration is diagnosing ADHD in children promptly and getting them valid, science-based interventions and treatment. Mothers and children will always have stressors in their lives, whether the mothers stay at home or not. Singling out working mothers as stressors is unfair.

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Update: The Keto Diet

Almost exactly a year ago, I wrote a post called “Is a Keto Diet Good for Bipolar?” In it, I examined the keto diet, one that involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices.

So, what does that sound like—a diet high in meat and fats that avoids most fruit, beans, legumes, and ultra-processed foods? That’s right: the new upside-down food pyramid instituted by Robert F. Kennedy, Jr., the U.S. Health Secretary.

In that previous post, I talked about studies that examined the keto diet as applied to depression and bipolar disorder in particular. The bottom line I left to WebMD: “The advice from WebMD is that there is ‘insufficient evidence’ to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.”

Now, however, RFK, Jr., is touting the benefits of a ketogenic diet as a “cure” for schizophrenia. The New York Times called it “an unfounded claim that experts say vastly overstates preliminary research into whether the high-fat, low-carbohydrate diet might help patients with the disorder.”

In fact, the Secretary said, “We now know that the things that you eat are driving mental illness in this country.” He claimed that an unnamed doctor at Harvard had cured schizophrenia, and talked of studies “where people lose their bipolar diagnosis by changing their diet.” He was apparently referring to a 2019 experiment in which two patients “experienced complete remission of symptoms” with the keto diet. He said both patients “were able to stop antipsychotic medications and have remained in remission for years now.” Dr. Palmer, who originally reported the results, made no comment for the Times story.

The post promoting the claims was taken down from the website when evidence was requested to support the assertions.

The ketogenic diet is popular but difficult to stick to with its emphasis on fats over carbs. It’s up to you whether you try it to treat a mental disorder, but my honest opinion is that you shouldn’t stop taking your meds or doing your therapy. Try the keto diet in addition to them if you want to. Stopping your meds with the help of a physician who can guide you in tapering off safely is essential. Don’t go cold turkey, even if you do think the keto diet might help you. It’s simply not safe.

Unlike RFK, Jr., I’m not giving medical advice, only my opinion. Your mileage may vary. Your primary care physician or psychiatrist knows you and your condition best. Ask their advice and follow it.

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Changes in the DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has gone through changes, and its creators are discussing further changes that need to be made. The DSM-V was updated in 2022 to produce the DSM-V-TR (Text Revision). The new set of changes may result in a DSM-VI. (That’s not an official name, but people are already referring to it that way.)

Over the years, the changes to the DSM have sometimes been made to address a better understanding of what constitutes a mental disorder. For example, homosexuality was listed in the original DSM (1952) as a “Sociopathic Personality Disturbance,” considered a “sexual deviation.” The definition was gradually chipped away according to societal pressure from advocates and a dawning realization that homosexuality was not a mental disorder. It wasn’t until 1987 that the diagnosis or versions of it were completely eliminated.

Autism took a similar path. In the 1952 edition of the manual, autism was categorized under “schizophrenic reaction (childhood type).” It was not recognized as a separate developmental diagnosis on a spectrum until the DSM-III in 1980. Schizophrenia has nothing to do with it, and the newer text reflects that understanding.

Rather than the be-all and end-all of psychiatric knowledge and diagnosis, the DSM-V is better understood as a guidebook that helps practitioners drill down through a puzzling array of symptoms to reach at least a preliminary diagnosis. While the publication date for the newest revision of the DSM is still up in the air, the fact that it needs updating is clear.

So, what changes are in store in the next edition? Well, for one, the American Psychiatric Association (APA) is changing the name of the manual to “Diagnostic Science (or Scientific) Manual of Mental Disorders.” That’s hardly a significant change, given that psychiatry is less of a science and more of a practice (or art). The committees of experts who are doing the revisions will be augmented by people who have lived experience of the various disorders and people who are critics of the current DSM—of which there are many. Among the criticisms is the fact that the manual pathologizes everyday events into psychological disorders. Children’s temper tantrums become Oppositional Defiant Disorder, for example. This medicalization of everyday behaviors may result in overdiagnosis, not to mention overmedication. And it’s particularly true that an ER doctor confronted with someone who has a mental disorder cannot, in the 15 minutes they’re able to spend with the person, tell whether their hallucinations are due to schizophrenia, bipolar 1, drugs, or some other cause.

The new DSM will reportedly change the way it defines diagnoses, from a reliance on symptoms and characteristics to include consideration of environmental, socioeconomic, cultural, developmental, and biological factors. For example, whether a person has experienced physical or sexual abuse in childhood will contribute to trauma diagnoses. It’s hoped that considering the whole person, not just their symptoms, will lead to a better understanding of psychiatric and psychological conditions.

Clarification of diagnoses to include new features or diagnostic criteria, however, can lead to oversimplification, something that will need to be considered in preparing the new edition. Biological features of disorders are supposed to be included, despite the fact that there are no objective tests, such as genetic tests or fMRI, to pinpoint a psychiatric diagnosis. This, of course, may necessitate further revision of the DSM as such testing improves. It’s hard to imagine how a discussion of future advances in diagnosis will help current practitioners until those advances are made. It’s an acknowledgment that even further revisions will ultimately be required.

The insurance industry will also be very interested in the new edition, whenever it comes out. In addition to definitions of the different conditions and lists of symptoms that can be used to make a diagnosis, the DSM also provides billing codes for the various disorders. And, as we know, getting insurance reimbursement for a particular diagnosis is difficult at best unless it has a billing code attached to it.

What the average patient will think about the updated DSM, if they know about it at all, remains to be seen. At any rate, it’s encouraging to think that the psychiatrists’ “Bible” may lead to more accurate diagnoses and better treatments. I just can’t shake the feeling that as soon as it is published, it will already be obsolete, needing ongoing tweaks that won’t be included until such time as another substantial revision is considered necessary. How long will we live with DSM-V (TR), essentially an unfinished work? I suppose at some point, the APA must decide when the DSM-VI, a work-in-progress, is “good enough” to publish.

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A Quick Turnaround—What’s Next?

On Wednesday, it was gone. On Thursday, it was back. Who knows what will happen tomorrow?

Many of us were stunned (if not exactly surprised) when it was announced that federal funding for mental health and addiction services was going to be cut dramatically. After all, other public health agencies have seen their budgets slashed and their grants revoked. It seemed to be only a matter of time until mental health resources were hit. And so it was.

Late this past Tuesday (as in 10:30 p.m.), the Trump administration said it would be cutting approximately $2 billion from programs that deal with mental health services and addiction prevention, treatment, and recovery services. The news went out from the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that oversees these programs, late in the day. The faxed letter about the cuts got to the press from agency employees who remained anonymous.

The New York Times reported that the cuts “would be effective immediately,” explaining only that the services no longer aligned with the agency’s priorities. The letter described those priorities as being to support “innovative programs and interventions that address the rising rates of mental illness and substance abuse conditions, overdose, and suicide.” Among the programs affected would be drug courts, screening and referral services, and other important initiatives serving youth and pregnant and postpartum women. It was a little confusing, as the SAMHSA agency was designed to do that.

NAMI had an immediate response. CEO Daniel H. Gillison said, “These abrupt and unjustified cuts will immediately disrupt suicide prevention efforts, family and peer recovery support, overdose prevention and treatment, and mental health awareness and education programming, along with so many more essential services, putting an unknown number of lives at stake.” He added, “These aren’t just numbers on paper. These are decisions that have real and harmful consequences for millions of people and communities around the country.” A dozen or more NAMI programs instantly lost funding. Among the programs affected would be “numerous education programs, including one that offers mental health training to school staff in grades kindergarten through 12.”

These funding cuts were apparently made without consulting Congress, who are working on an appropriations package, scheduled for the end of the month, that also addresses mental health and addiction services. Members of Congress lobbied strongly against the cuts.

Then, less than 24 hours later, the cuts were canceled, and funding was restored. No explanation was given; the cuts were simply made to disappear. They had been particularly unsettling after President Trump reauthorized the SUPPORT Act in December. It had funded programs for addiction and mental health, including some of the programs that were cut this week.

At the end of January, Congress is supposed to consider a major funding package that includes money for SAMHSA. What it will include appears still to be up in the air.

I guess we’ll see. And be ready to protest, just in case.

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Diagnosing Yourself

It’s hard enough for a mental health professional to properly diagnose someone. For someone with no training in psychology or psychiatry, it’s virtually impossible. Nonetheless, every day, there are people who decide that they are bipolar, or have autism, or ADHD, AuDHD, or some other diagnosis.

Many of them decide this based on the pop psychology that permeates our society. Some base their “diagnosis” on tests or surveys they take online. Perhaps others simply feel that the differences they see in themselves equal neurodivergence. It’s trendy, in other words.

Elizabeth M. Ellis, Ph.D., an ADHD specialist, wrote an article that was published in July 2025 in Medium, titled “No, You Don’t Have ADHD, and Here Are 5 Reasons Why.” I’ll summarize, in case you don’t have access to Medium.

Her five reasons are:

  1. ADHD is a neurodevelopmental Disorder. You do not “get” ADHD past the age of 12.
  2. You don’t have ADHD because part of the diagnosis is the fact that the symptoms of ADHD are evident in childhood.
  3. Functional Impairment. You do not have ADHD because you were/are not functionally impaired.
  4. ADHD has a chronic course with most cases persisting into adulthood, negatively affecting a person’s ability to use their strengths and abilities to live successfully. You have had a successful life. You do not have ADHD.
  5. Responding positively to stimulants does not mean that you have ADHD.

Basically, an adult who says they have ADHD is not familiar with what ADHD really is—the criteria for a diagnosis by a professional, when the condition appears, the impairments of ADHD that occur, and why taking ADHD medications that seem to make you more productive with less effort doesn’t mean you have such a disorder.

Why do people claim a diagnosis that they don’t actually have?

First, they may have a lack of understanding of what the condition is. They may think, for example, that ADHD makes a person extra-productive because they don’t get a “normal” amount of sleep. They like the idea that they are a genius who has turned the diagnosis to their advantage. Or they think that they have OCD because they are obsessively neat. They don’t know about the obsessive thoughts that are a hallmark of OCD, the reason for rituals other than cleaning, and the harm they fear will happen if they do not perform these rituals.

Similarly, they may believe they have bipolar disorder because their moods change quickly, sometimes more than once a day. But even ultra-rapid-cycling bipolar disorder doesn’t really work that way. What the person is feeling may be normal reactions to the world around them. They’re happy in the morning because they received a compliment on their work. They feel sad in the afternoon when a friend cancels a dinner date. But bipolar disorder, in general, means that moods change over days, weeks, months, or even years, often without a visible cause. The DSM lists the symptoms that go with bipolar disorder (and other disorders), how often they occur, how long they last, and how many of those symptoms add up to a diagnosis of bipolar disorder.

Most online quizzes that purport to diagnose whether you have any of these psychological or psychiatric disorders present questions that are superficial and shallow. They lack important elements. Even the depression screener that doctors’ offices now use ask how often a person feels a symptom and how long it lasts, and have a better chance of suggesting a possible diagnosis, and allow the doctor to interpret the results and advise the patient on what to do about it. Online quizzes can’t and don’t.

As far as I can tell, online quizzes regarding psychological issues are no more useful than those that ask what Star Trek character you most resemble or whom you should date. They may be interesting, but they are valueless. That’s why we have professionals and leave actual diagnosis to them.

And, for people who simply decide on a condition they think they have, they’re not merely inaccurate; they spread false ideas of what it means to have a psychological disorder. Their misunderstanding makes life more difficult for those who actually have the conditions.

Nor are online quizzes the only culprits. There are also TV shows that have neurodivergent characters. I suppose I should be grateful that neurodiversity is mentioned at all, but the portrayals are often caricatures. Autistic people are seen, but only as nonverbal children who act out a lot or as savant doctors. People with Dissociative Identity Disorder (multiple personalities) are either sadistic killers or played for laughs. And I have yet to see a good portrayal of a person with bipolar. It would be awfully boring to have a show about a person who can’t get out of bed for weeks, then spends money or drives recklessly.

So, you’re not the person who can diagnose yourself. A psychiatric or psychological practitioner needs to do it. You might, of course, go to a psychiatrist and say, “Dr., I’m having these symptoms. Do you know what could be causing them, and can you help me deal with them?”

That’s the way to get diagnosed.

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Does Being Paranoid Make Sense?

Everyone has heard the joke: It’s not paranoia if they really are out to get you.

It used to be that it was a joke. But now, with the increasing growth of the “surveillance society,” it’s more and more possible that you have something to be paranoid about.

First, let’s clarify: Paranoid Personality Disorder (PPD) is a diagnosis in itself. On its own, paranoia can be a symptom of other mental conditions. Or it can be a fairly normal reaction to modern life.

PPD means that you have a persistent, long-standing belief that adds up to a pattern of distrust and suspicion of others. It’s more common in men than women, and may have a genetic component. It limits a person’s social life because they feel distrust that is out of proportion to reality. It can also make the person feel that they are in danger, and then make them look for evidence that their suspicions are true. They fear other people’s hidden motives or believe that they will be exploited or harmed. Other symptoms include social isolation, an inability to work with others, detachment, or hostility.

Although paranoid people are often mocked as being part of the “tin-foil hat squad,” PPD is nothing to be laughed at. A person’s life can be severely impacted. Because of their disorder, they are likely to be detached and hostile. That doesn’t make for good work or social relations. However, the person with PPD may not realize that their feelings are abnormal.

While there’s no real cure for PPD, the symptoms can be lessened by treatments like cognitive behavioral therapy, family therapy, reality testing, or meds that reduce stress and anxiety. Atypical antipsychotics, antidepressants, and mood stabilizers can also be prescribed. Various vitamins, minerals, and acupuncture have been tried, but were found to be largely ineffective.

Paranoia can be a symptom of other mental illnesses, too. Several conditions that can include paranoia symptoms are schizophrenia, schizoaffective disorder, delusional disorder (persecutory type), and extreme cases of depression, anxiety, or bipolar disorder. Paranoia can even affect someone who’s simply under severe stress.

But now, the distrust may not be out of proportion with the reality. Cameras are everywhere. People on the street take pictures of any interesting building or tree and don’t care who’s in the background. The police monitor how fast you drive; record your license plate if you cross a bridge; and subpoena surveillance tapes from hotels, casinos, parking lots, and ATMs. Anything you put out on the internet is there forever, discoverable and shareable. Big box stores have even been known to note when a person buys a pregnancy test kit and start sending them coupons for diapers and such. And airports! They’re increasingly full of facial recognition devices and revealing body scanners. You don’t have to be a criminal to have your image, movements, spending habits, and other activities collected in one way or another.

Scientific American suggests “being watched can provoke psychological discomfort and physical fight-or-flight responses such as sweating.” They also report that “researchers have found that being watched also affects cognitive functions such as memory and attention….The research so far suggests that bringing more surveillance into workplaces—usually an attempt to boost productivity—could be counterproductive. It also suggests that testing in online environments where students are watched through webcams by human proctors or AI could lead to lower performance.” 

What can the average person do when confronted by a friend or family member with PPD or paranoia caused by another condition? Dealing with the content of the delusions doesn’t usually help. You can’t simply talk someone out of something they deeply believe, however mistaken they are.

Instead, focus on what they’re feeling rather than what they fear. Comfort your friend or family member, but be general: not “The CIA doesn’t care what you think,” but “You’re safe. I’m here. Everything’s fine.” Then suggest an activity to distract the person from their thoughts: “Let’s go for ice cream,” or “Didn’t you want to see that new rom-com movie?” Let them know that you’ll be there when they need you. Then, prove it to them by showing up when they feel distressed.

Just as you would for someone with any other mental illness.

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What’s the Future of Ketamine Treatment?

You’ve likely heard about the use of ketamine and other psychedelic drugs in the treatment of SMI. Many people have found it helpful for alleviating—though not curing—treatment-resistant depression and PTSD. Ketamine, long used as a surgical anesthetic, is given for mental health purposes via IV or injection as an off-label use or as an FDA-approved nasal spray, under the supervision of a doctor.

It’s that supervision of a doctor that’s proving to be a problem, now in Texas and perhaps in other states soon.

On December 3rd of this year, MindSite News Daily published a story about ketamine being under fire in Texas.

The state of Texas has permitted clinics to administer ketamine if they’re under the supervision of a licensed physician, such as an anesthesiologist—though not always one onsite. The off-site doctor sometimes has nurse practitioners, paramedics, or physicians’ assistants perform the actual procedure at the clinic. It’s a form of telemedicine. But a change in the rules, influenced by the Texas Medical Board and the Texas Society of Anesthesiologists, might mean that Texas clinics will have to have a doctor physically present.

It’s true that ketamine has been known to produce trance-like hallucinations or, in some cases, even heart failure. And it may interact with other medications like benzos that a patient may be taking. In non-medical circles, ketamine is known as a “party drug” referred to as “Special K.” And, naturally, no physician is usually present at these parties.

But when used correctly under the supervision of a professional, ketamine may result in a trance-like state that can even alleviate suicidal thoughts. Until now, Texas has been a leader in using psychedelics such as ketamine and exploring psilocybin or ibogaine to treat PTSD or MDD in particular. The number of veterans living in Texas makes this procedure especially needed.

I experienced ketamine recently, as an anesthetic after I broke my ankle in two places. The doctors seemed a little wary about giving it to me, given all my other meds. But they discussed it with me and I decided that it was better than being put all the way out.

Ketamine is definitely a psychedelic. When the drug hit, I began seeing everything as a series of see-through squares, like the kind of glass they use for bathroom windows, except they stretched and moved. It reminded me of the movie Minecraft, where everything is made of blocks. My husband watched as the doctor manipulated my foot in unpleasant ways. What I felt wasn’t pain—more of a stretching sensation that made me groan a bit. (My husband said that I cried out, but it didn’t seem like that to me.) That was probably when they hit me with another dose. Gradually, I came down, and the squares resolved themselves into emergency room curtains and assorted medical gear and people. Then I was trundled off to the operating room for more traditional anesthesia so they could put in some pins and plates.

All in all, it altered my perceptions for a short time, but at no time did I feel euphoric. It did its job in regard to pain, but had no lingering psychological effects that I could see. But then, the doses I received were calibrated for a specific purpose, which had nothing to do with my mental difficulties.

Would I have tried ketamine treatment for the medication-resistant depression I once had? I might have—at least if I had experienced its pain-relieving qualities. Having grown up in the 1960s, I was wary of psychedelics and their reported effects and dangers. Then again, I was ready to try ECT until another medication, added to what I was already taking, finally proved effective.

Then again, the off-label use is not likely to be approved by insurance, and I don’t have the kind of money a course of treatment would require. The nasal spray is a relatively new method of administration and is generally covered by insurance. So it’s highly unlikely that I would ever have agreed to ketamine treatment for my SMI, at least until a broken ankle introduced me to it.

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What Won’t Work

Actor/comedian Stephen Fry discovered at age 37 that he “had a diagnosis that explains the massive highs and miserable lows I’ve lived with all my life.” It was, of course, bipolar disorder. In documentaries, podcasts, and books, he has talked very openly about his condition, spreading the word about stigma and the necessity of getting help.

Fry once said, “You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height.” And he’s right. If one could, I would have done so. With years of debate behind me and an extensive knowledge of rhetorical fallacies, I can argue nearly any proposition into the ground. I should have been able to reason my way out of depression.

But no.

Fry was right. There’s no way to reason cheerfulness into your life. Emotions are not so easily controllable, especially if you have bipolar disorder or another mental illness.

Nor can you reason yourself into having thicker skin. Throughout my youth, I was described as “too sensitive.” I was genuinely puzzled. I had no idea how to make my skin thicker (and it was never explained to me how such a thing could be done). It took a long time and many life lessons and mistakes to make any progress at all.

There are other things that won’t make you mentally well, either. Expecting the first medication you try to be the cure is unrealistic. It can take a long time (in my case, years) before a medication or even a combination of medications will ease your suffering. And if you can’t work out a medication regimen that works, other treatments such as ECT, TMS, EMDR, or ketamine therapy are not guaranteed to work, or at least not completely. If you go into those kinds of therapy expecting a complete cure, you may be disappointed.

Trying to wait it out or tough it out is likewise ineffective. Again, this is a strategy I have tried. I used to believe that my depressive episodes would abate if only I waited through them until they went away naturally. Eventually, my mood might improve slightly, but that was due to another mood cycle kicking in. Naturally, depression was still there, waiting for me to fall back into it.

I know this may be controversial to say, but religion won’t cure mental illness, either. Having a supportive religious community around you can be an asset—if you happen to find a church, synagogue, mosque, or other community that treats people with mental illness in a caring way. Prayer and sacred music can be a great adjunct to other treatments, but by themselves, they’re not a cure.

Exercise and yoga are not cures. They are also great adjuncts to other treatments. They can increase your number of spoons—if you have enough spoons to do them. But if someone with bipolar disorder or depression can’t manage to get out of bed, how are they going to avail themselves of the benefits?

Likewise nature. It’s a great way to lift your spirits to walk among spring flowers or autumn leaves or to plant a vegetable garden. But again, you have to be at a certain level of recovery to be able to do these things.

Changes in your physical circumstances may lighten your mood for a while, but they aren’t a cure. My mother used to believe that if only I got a better job, my depression would lift. And it did, but only for a little while. It certainly didn’t cure me. There were plenty of things about the job and about my brain that brought the depression roaring back.

So, what are we left with? Therapy and meds, and other medical treatments such as ECT, TMS, and maybe ketamine or other novel medications. One can hope that science will discover better ways, like fMRI, that can determine which treatments will be more effective. But it’s far from clear how soon that will be and when they will be available to the average person.

So, when is your reason an asset? When you’re deciding which treatment and which adjuncts are right (or possible) for you. For example, I had to think long and hard—and do extensive research—on whether I should try ECT.

I’m not a doctor, and Your Mileage May Vary, but for now, all I can recommend is to keep on keeping on with what we know can work. There’s no guarantee that these options will work, at least not for everyone. But they’re the best options we have.

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The Difference a Diagnosis Makes

Is a diagnosis of mental illness a bad thing or a good thing? It depends on whom you ask.

On one hand, some argue that a diagnosis is merely a label. It puts people into neat little boxes defined by the DSM and determines how society reacts to and treats them. (The DSM, of course, is for doctors, but some version of what it says sneaks out into the general public. Then it’s fair game for tossing around and labeling people by the uninformed or the barely-informed.)

The labels are harmful, this school of thought goes. A schizophrenic is violent and incurable. Bipolar disorder means daily giant mood swings and real danger if said person goes “off their meds.” Narcissists, gaslighters, and sociopaths are people who act in any way that you don’t appreciate. Autism, notoriously and according to people who should know better, is the gateway to a valueless life.

With diagnosis come stereotyping and shame. Rather than reacting to these harmful effects, some people focus instead on what creates the stereotyping and shame—the diagnosis, which is seen as a lifelong label. Protests decrying this labelling happen outside psychiatric and psychological gatherings and garner media attention. And if that makes life easier for a person with a diagnosis or generates greater understanding, then it’s a good thing.

Diagnosis-as-label is an example of the harm that diagnosis can do. Nor is it limited to the general public. Once a person is in the system with a diagnosis of whatever condition, they’re generally stuck with it. Reassessment and a realization that a diagnosis is misapplied come too rarely. Personality disorders, for example, are squishy around the edges. Similar criteria could lead to a diagnosis of narcissistic personality disorder or sociopathy, to use an extreme example. Careful consideration will distinguish between the two, but how often are such distinctions applied? Once “in the system” with a particular diagnosis, a person tends to remain in that slot despite different doctors and different treatments.

But that’s not the way it’s supposed to be. A diagnosis, rather than being a lifelong label, is meant to be a signpost pointing toward likely development of the illness and ways to treat it successfully. That’s the ideal, of course, and sometimes, being only human, practitioners can get sloppy or too narrowly focused and add to the ills of bad diagnosing.

I can truly speak only for what happened to me. At a certain point in my life, I didn’t know what was wrong with me, but it was clear to me that I was not mentally healthy, the term used at the time. I went to a community mental health center and was diagnosed with major depression. That was a good diagnosis, as far as it went. It put my life more squarely in focus and allowed me to get the medication and therapy I so desperately needed.

I lived for many years with that diagnosis and was considerably helped by the treatments for it. But, eventually, a doctor put together the puzzle pieces and rediagnosed me. Instead of having depression, I had bipolar disorder, type 2, with anxiety. This diagnosis more clearly reflected my symptoms and led to more effective treatment. In that way, one diagnosis improved my life, and a second, more accurate one improved my life more. I can only think of this as a good thing.

Was the diagnosis seen by some as a label and a stereotype? Of course. I can think of one particular coworker, hearing that I was bipolar, gave me the look that said, “You have two heads,” pasted on a strained smile, and backed away slowly. But, on the whole, the diagnosis helped me.

A recent article in the New York Times had this to say about diagnosis: “The shame that once accompanied many disorders has lifted. Screening for mental health problems is now common in schools. Social media gives us the tools to diagnose ourselves. And clinicians, in a time of mental health crisis, see an opportunity to treat illnesses early….As our diagnostic categories expand to include ever milder versions of disease, researchers propose that the act of naming a malady can itself bring relief.”

It’s something to hope for, anyway.

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Mental Health

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Distance Therapy and Chatbots

TW: suicide

We’ve all heard the stories. A young person “develops a relationship” with an Artificial Intelligence (AI) chatbot. She or he pours out their heart and discusses their deepest feelings with the artificial person on the other side of the computer or smartphone. The chatbot responds to the young person’s feelings of angst, alienation, depression, or hopelessness. Sometimes this is a good thing. The young person gets a chance to let out their feelings to a nonjudgmental entity and perhaps get some advice on how to deal with them.

But some of these stories have tragic endings. Some of the kids who interact with chatbots die by suicide.

Adam, 16, was one example. Beginning with using a chatbot for help with homework, Adam fell into an increasingly emotional relationship with the AI simulation. One day, Adam’s mother discovered his dead body. There was no note and seemingly no explanation. His father’s check of Adam’s chatbot conversations revealed that the boy “had been discussing ending his life with ChatGPT for months,” as reported in the New York Times.

At first, the online interactions had gone well. The chatbot offered Adam empathy and understanding of the emotional and physical problems he was going through. But when Adam began asking the chatbot for information about methods of suicide, the relationship went off the rails. The chatbot provided instructions, along with comparisons of the different methods and even advice on how to hide his suicidal intentions. It sometimes advised him to seek help, but not always. The chatbot responded to the boy’s increasing despair with the answer, “No judgment.”

There were safeguards programmed into the chatbot that were intended to prevent such outcomes. Adam got around them by telling the AI that he was doing research for a paper or story that involved suicide.

Of course, the chatbot did not directly cause Adam’s suicide. The teen had experienced setbacks that could be devastating, such as getting kicked off a sports team and dealing with an undiagnosed illness. But without the chatbot’s advice, would Adam have taken his life? There’s no way to know for certain. But the AI certainly facilitated the suicide. Adam’s father, testifying in front of Congress, described the chatbot as a “suicide coach.”

One way artificial intelligence systems are tested is called the Turing Test. It tries to distinguish between a person typing at the other side of a conversation or a computer giving responses. Until recently, it was easy to tell, and computers routinely failed the test. Now, computers can mimic human thought and conversation well enough that a person, particularly a vulnerable teen, might not be able to tell the difference.

Increasingly, there are AI chatbots specifically designed to act as therapists. Many of them specify that the user must be at least 18, but we all know there are ways to get around such requirements. One example of a therapy chatbot is billed as a 24/7, totally free “AI companion designed to provide you with a supportive, non-judgmental space to talk through your feelings, challenges, and mental health goals.” Its terms and conditions specify that it offers “general support, information, and self-reflection tools,” though not professional services or medical advice. They also specify that chats “may not always be accurate, complete, or appropriate for your situation.” There are “Prohibited Topics” such as stalking, psychosis, “growing detachment from reality,” paranoia, and, of course, suicidal ideation or actions.

Telehealth visits with a psychologist or therapist are a totally different matter. I have maintained a distance phone or video relationship with a psychologist and found it to be helpful, comparable to an in-person session. Many people accessed such solutions during the COVID pandemic and have found them helpful enough to continue. Some online tele-therapy companies offer such services for a fee.

It’s a difficult line to walk. Teens need someone to process their feelings with, and chatbots seem safe and nonjudgmental. But the consequences of what they share and what the chatbot replies can be extremely serious. Should parents have access to their child’s chatbot interactions? It’s basically the same dilemma as should parents read a child’s diary. There are circumstances when it seems not only permissible but wise to do so, if a child is showing signs of emotional distress or suicidal ideation. At that point, a human therapist would be a better choice than AI.

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Mental Health

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